Antibiotic Stewardship in the United States: Antibiotic Over-prescription, Factors Associated with Antibiotic Prescription, and People’s Awareness of Antibiotic Resistance

Abstract

Antibiotics touch upon almost all aspects of our modern life. They contribute towards increasing life expectancy by reducing the negative outcomes of bacterial infections. Unfortunately, antibiotics tend to lose their effectiveness over time due to the emergence of antibiotic resistant bacteria. The overuse, misuse, and over-prescription of antibiotics all lead to the development of antibiotic resistant bacteria. This dissertation is a series of three studies that build on each other, each addressing different aspects of the human and organizational factors associated with antibiotic overuse, misuse, and over-prescription in the United States.

Study I: The first study focuses on the reasons for antibiotic over-prescription from the point of view of family medicine residents. This qualitative study strives to better understand why medical professional prescribe antibiotics in cases in which antibiotics are not necessary or not useful. The findings suggest that physicians’ behaviors of over-prescribing antibiotics are affected by the organizational conditions within the medical practice including the use of an antibiotic control system and by patients’ expectations.

Study II: The second study assesses the potential associations between the duration of visit with a doctor and antibiotic prescriptions for viral infections in outpatient settings. The assessment was done by utilizing National Ambulatory Medical Care Survey data. The results from multivariate logistic regression showed that for every additional minute spent with a physician during an office visit, the mean probability of receiving unnecessary antibiotic prescriptions decreased by 2.4%.

Study III: The third is a qualitative study of the general public’s experiences and awareness of antibiotic overuse and antibiotic resistance. Focus groups conducted with twenty people who have traveled into the United States from countries with unrestricted access to antibiotics revealed a paucity of knowledge and awareness of antibiotic resistance and appropriate antibiotic use that must be addressed for any antibiotic stewardship policy to be successful.

Despite the very restrictive policies overseeing antibiotic use in the United States, physicians tend to over-prescribe antibiotics and patients often insist on receiving a prescription. The findings of these studies show the need to educate patients through healthcare providers about the consequences of antibiotic overuse and misuse. This would curb the rate of antibiotic overuse, over-prescription, and subsequently, antibiotic resistance.